Interstitial cystitis: A complex visceral pain syndrome

Abstract

Case reports of patients with painful idiopathic bladder ulceration and symptoms of dysuria and frequency first appeared in the late 19th century. The term interstitial cystitis (IC) was coined soon after, yet for nearly a century this disorder has been underrecognized or dismissed as a psychosomatic symptom complex seen mostly in women. Since the mid-1980s, patient self-advocacy has won federal and other support to develop consensus approaches to the clinical diagnosis and evaluation of IC, and to investigate its pathophysiology. Diverse etiologies, many supported by credible preclinical models, have been advanced for this disorder or group of disorders. Treatments remain heterogeneous and empirical. Recent insights into visceral pain and hyperalgesia, together with clinical and basic research on IC, suggest that self-sustaining peripheral and central nociceptive sensitization after any of several inciting events is the final common pathway that leads to IC. IC shares many features in common with other debilitating, self-sustaining neurogenic pain syndromes recognized in other visceral organs or somatic sites. One may advance the term complex visceral pain syndrome to encourage a holistic and mechanistic rather than organ-specific, empiric approach to the diagnosis, treatment, and taxonomy of chronic neurogenic pain evoked by a spectrum of insults to distinct visceral organs.